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MSRA Revision > Surgery (Vasc, Colo, UGI, Breast...) > Flashcards

Surgery (Vasc, Colo, UGI, Breast...) Flashcards

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1
Q

Anastrozole

  1. Class of drug?
  2. Indication (and why)?
  3. Main risks?
  4. Any pre-investigations required?
A

Anastrozole

  1. Aromatase Inhibitor
  2. Treatment of ER +ve breast CA in postmenopausal women - aromatisation accounts for majority of oestrogen in postmenopausal women
  3. Osteoporosis, arthralgia, myalgia
  4. DEXA scan - due to osteoporosis risk
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2
Q

Tamoxifen

  1. Class of drug?
  2. Indication?
  3. Risks?
A

Tamoxifen

  1. Selective Oestrogen Receptor Modulator (SERM) - Antagonist and partial agonist
  2. ER +ve breast CA
  3. VTE risk, endometrial CA, menstrual disturbance, hot flushes
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3
Q
  1. What are the two main sub-types of testicular CA?

2. Which has a worse prognosis?

A
  1. Seminomas and teratomas

2. Teratomas

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4
Q

Risk factors for testicular CA?

A

Infertility
Cryptorchidism
Family history, mumps orchitis
Klinefelter’s syndrome

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5
Q

Presenting features of testicular CA?

A

Testicular lump - painless
Hydrocoele
Gynaecomastia

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6
Q

Testicular CA - tumour markers?

A

hCG

AFP

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7
Q

Testicular CA

  1. Diagnosis?
  2. Treatment?
A

Testicular CA

  1. USS
  2. Orchidectomy +/- RT, chemo
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8
Q

Peripheral Arterial Disease - Management

  1. Conservative measures?
  2. Drugs for all patients (2)?
  3. Last-line drug for patients with poor QoL?
A
  1. Stop smoking, exercise, treat co-morbidities
  2. Statin & Clopidogrel
  3. Naftidrofuryl oxalate (vasodilator)
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9
Q

Aortic Dissection

  1. Presentation?
  2. Associations / risk factors?
  3. Classification?
  4. Imaging of choice?
A

Aortic Dissection
1. Tearing chest pain to back, weak pulses, HTN
2. HTN, Trauma, Marfan’s, Pregnancy
3. Type A = ascending aorta
Type B = descending aorta distal to L subclavian

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10
Q

Ascending Cholangitis

  1. Main bug?
  2. Name of classical triad?
  3. 4 features of triad?
  4. Diagnostic modality?
  5. Treatment?
A

Ascending Cholangitis

  1. E Coli
  2. Charcot’s Triad
  3. RUQ pain, fever, jaundice, raised inflammatory markers
  4. USS
  5. IV Abx, ERCP 24-48hrs after presentation to relieve obstruction
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11
Q

Colorectal CA Referral Criteria?

A

Unexplained weight loss and abdo pain >40
Unexplained PR bleed >50
IDA or change in bowel habit >60
+ve FIT

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12
Q

Faecal Immunochemical Test (FIT)

1. Screening details?

A

FIT

1. 60-74yo, or suspicion of bowel CA due to symptoms not quite meeting 2ww criteria

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13
Q

Renal Stones

  1. Diagnostic Modality?
  2. Drugs can give in ED?
  3. Drugs can give for medical management?
A

Renal Stones

  1. CT KUB
  2. Diclofenac
  3. Tamsulosin (alpha-blocker)
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14
Q 
Renal Stones - Management
What management option in the following?
1. Emergency (obstruction, previous transplant, infection)
2. Stone 2-5mm, non-pregnant?
3. Stone 2-5mm, pregnant?
4. Stone <5mm
5. Stone complex / staghorn calculus?
A

Renal Stones - Management

  1. Emergency = nephrostomy / stent to decompress
  2. 2-5mm and non-pregnant = shock wave lithotripsy
  3. 2-5mm and pregnant = ureteroscopy
  4. <5mm = conservative (Tamsulosin, watch and wait)
  5. Complex = percutaneous nephrolithotripsy
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15
Q

Chronic Pancreatitis

  1. Classic presentation?
  2. Risk factors?
  3. How to look for exocrine dysfunction?
  4. Imaging modality and finding?
  5. Treatment?
A

Chronic Pancreatitis

  1. Pain after fatty meal + steatorrhoea + diabetes
  2. Alcohol, CF, ductal obstruction
  3. Faecal elastase
  4. CT (calcification)
  5. Pancreatic enzyme supplement, analgesia, stop EtOH, treat obstruction
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16
Q

Acute Wound Dehiscence - Immediate Management (3 steps)

A
  1. Cover with saline-soaked gauze (prevent fluid loss)
  2. IV Abx
  3. Senior +/- theatre
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17
Q

Haemorrhoids

  1. Grading (1-4)?
  2. Treatment?
A

Haemorrhoids
1. Grade I - no prolapse
Grade II - prolapse on defaecation, spontaneously reduce
Grade III - manually reduce
Grade IV - cannot reduce
2. Fibre, local anaesthetics and steroids, rubber band ligation

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18
Q

Priapism

  1. Definition?
  2. Classification, which is more dangerous?
  3. Investigations?
  4. Treatment?
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A

Priapism

  1. Erection >4hrs not related to sexual stimulation
  2. Ischaemic (more dangerous, impaired vasorelaxation), non-ischaemic (less dangerous, high arterial inflow, e.g. congenital)
  3. Cavernosal blood gas analysis, Doppler USS in young children
  4. Aspirate blood from cavernosa / surgery
19
Q

Breast CA Screening

  1. Screening Details?
  2. Criteria for referring for familial breast CA screening?
  3. Referral for non-screening referral?
Study These Flashcards
A 
Breast CA Screening
1. 50-70y, every 3y
2. 1st/2nd degree relative +one of:
Age>40
B/L breast CA
Paternal side breast CA Hx
Male breast CA
Ovarian CA
Sarcoma in <45y
Jewish heritage
3. Age >30 and unexplained lump
Age >50 and nipple changes
20
Q

Volvulus
Which type of volvulus:
1. 80% cases, large bowel
2. 20% cases, small bowel

Study These Flashcards
A

Volvulus

  1. Sigmoid
  2. Caecal
21
Q

Breast CA

  1. Most common sub-type?
  2. What is Paget’s disease of the nipple?
Study These Flashcards
A

Breast CA

  1. Invasive ductal carcinoma
  2. Eczematous changes around the nipple, indicative of CA
22
Q

Breast CA - Management

  1. When mastectomy?
  2. When WLE?
  3. Adjuvant therapy?
  4. Hormone therapy: when indicated?
  5. Hormone therapy: pre-menopausal?
  6. Hormone therapy: post-menopausal?
  7. S/Es of SERMs?
Study These Flashcards
A

Breast CA - Management

  1. Multifocal, central, large lesion, DCIS >4cm
  2. Solitary, peripheral, small lesion, DCIS <4cm
  3. RT for WLE / mastectomy if T3/4 or >4 nodes
  4. ER+ve breast CA
  5. Pre-menopausal = Tamoxifen (SERM)
  6. Post-menopausal = Anastrozole (Aromatase Inhibitor)
  7. VTE, endometrial CA, menopausal symptoms
23
Q

Hernias

  1. Inguinal location?
  2. Femoral location?
  3. Which has higher rates of strangulation?
Study These Flashcards
A

Hernias

  1. Supero-medial to pubic tubercle
  2. Infero-lateral to pubic tubercle
  3. Femoral
24
Q

Hernias

  1. Define incarceration
  2. Define strangulation
Study These Flashcards
A

Hernias

  1. Cannot reduce, risk of strangulation
  2. Tender, systemically unwell, surgical emergency
25
Hernias in children | Management?
Hernias in Children | Surgical repair immediately (high risk of strangulation
26
Prostate CA | 1st line investigation for high PSA?
Prostate CA | MRI
27
UGI Ulcers 1. Relieved by eating? 2. Worsened by eating?
UGI Ulcers 1. Duodenal Ulcer 2. Gastric Ulcer
28
Breast Lumps | Young, non-tender, mobile
Fibroadenoma
29
Breast Lumps | Lumpy breasts
Fibroadenosis
30
Breast Lumps | Nipple changes, irregular hard lump, tethering
Breast CA
31
Breast Lumps | Eczematous thickening of nipple
Paget's disease (=CA)
32
Breast Lumps | Tender lump +/- green discharge
Mammary Duct Ectasia
33
Breast Lumps | Blood-stained discharge
Duct Papilloma
34
Breast Lumps | Large breasts, trauma leading to lump
Fat Necrosis
35
When to Stop Drugs Before Surgery 1. Aspirin 2. Warfarin 3. NSAIDs 4. COCP 5. Parkinson's 6. DMARDs 7. Clopidogrel 8. SERMs e.g. Tamoxifen 9. Antihypertensives 10. LMWH
When to Stop Drugs Before Surgery 1. Aspirin - 5 days 2. Warfarin - 5 days 3. NSAIDs - 1 day 4. COCP - 4 weeks 5. Parkinson's - don't stop 6. DMARDs - stop before orthopaedic procedures 7. Clopidogrel - 5 days 8. SERMs e.g. Tamoxifen - 1 week 9. Antihypertensives - day of surgery 10. LMWH - 12-24hrs
36
Diabetic Drugs Before Surgery 1. When VRII? 2. Metformin OD/BD 3. Metformin TDS 4. Sulfonylureas 5. DPP-IV Inhibitors (Gliptins) 6. GLP-1 (-tides) 7. SGLT-2 inhibitors (-flozins) 8. Long-acting insulin (e.g. Lantus) 9. Biphasic insulin (e.g. Novomix)
Diabetic Drugs Before Surgery 1. VRII: more than one meal missed, poor glycaemia control, risk of renal injury 2. Metformin OD/BD = take as normal 3. Metformin TDS = omit lunchtime dose 4. Sulfonylureas = omit doses pre-surgery on day of surgery only 5. DPP-IV Inhibitors (Gliptins) - take as normal 6. GLP-1 (-tides) - take as normal 7. SGLT-2 inhibitors (-flozins) - omit on day or surgery 8. Long-acting insulin (e.g. Lantus) - reduce dose by 20% 9. Biphasic insulin (e.g. Novomix) - half morning dose
37
Vasectomy | What steps do you have to take before stopping barrier contraception?
Vasectomy | Semen analysis demonstrating azoospermia at 16 and 20 weeks post-op
38
Subarachnoid Haemorrhage 1. Treatment: raised ICP 2. Treatment: stable 3. Diagnosis? 4. After surgery, treatment?
SAH 1. Raised ICP = craniotomy and clipping 2. Stable = coiling 3. CT first, LP >12hrs (xanthocromia) if CT -ve 4. Nimodipine 21 days and relative hypovolaemia
39
``` Colorectal CA Operations What surgery based on site? 1. Emergency perforation 2. Sigmoid 3. Caecum, ascending/proximal transverse 4. Rectum 5. Anus 6. Distal transverse, descending ```
1. Emergency perforation - Hartmann's procedure (end colostomy) 2. Sigmoid - High anteroir resection 3. Caecum, ascending/proximal transverse - Rt hemicolectomy 4. Rectum - Anterior resection 5. Anus - AP excision of rectum 6. Distal transverse, descending - Left hemi
40
AAA 1. Cut-off for normal AA size? 2. Cut-off for "aneurysm"? 3. Main RFs?
AAA 1. <1.5cm female, <1.7cm male 2. 3cm 3. Smoking, HTN, Marfan's
41
Acute Pancreatitis | What criteria are in the Glasgow scoring system?
``` Acute Pancreatitis PaO2 <78 Age >55 Neuts >15 Calcium <2 Renal: urea >16 Enzymes: LDH >600 Albumin <32 Sugars: glucose >10 ```
42
Acute Pancreatitis | Main management?
Acute Pancreatitis 1. Aggressive fluids 2. Monitor U/O 3. Analgesia 4. Good nutrition 5. ERCP / surgery
43
Testicular Swellings Cause for the following: 1. Posterior to testicle, separates from testicle 2. Soft, non-tender, transilluminating swelling, associations with torsion and CA 3. L-sided swelling, bag of worms 4. Painless lump, cannot separate from testicle 5. Cannot get above it, separates from testicle
Testicular Swellings 1. Posterior to testicle, separates from testicle - epididymal cyst 2. Soft, non-tender, transilluminating swelling, associations with torsion and CA - hydrocoele 3. L-sided swelling, bag of worms - varicocoele 4. Painless lump, cannot separate from testicle - CA 5. Cannot get above it, separates from testicle - inguinal hernia

MSRA Revision (6 decks)

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